Harmonizing expression of measurement results in wine analysis: Best practices when testing and reporting sugar in wine

This technical brief addresses using appropriate methodology and uniform terminology to ensure consistency in measurement and interpretation of wine components described as sugars, when required in wine trade. Different analytical approaches when testing for sugar in wine, variation in reporting units, and non-uniform interpretation of sugar terminology are known to create unnecessary barriers in wine trade. This brief proposes a unified system of reporting sugar in wine that is grounded in scientific and practical knowledge to reduce potential trade barriers. The following are suggested best practices when testing and reporting sugar in wine: clarify the meaning of the abbreviation “RS” when used, since it could stand for residual sugars, reducing sugars, or reducing substances, which have different meanings (1), define residual sugar as the sum of glucose, fructose and sucrose expressed as g/L of wine (2), use methods that are specific for wine sugars, rather than non-specific methods that test for reducing substances, to avoid erroneously high results (3), avoid reporting sugar alcohols, such as glycerol, as a sugar (4), avoid testing for sugars not expected in wine, such as maltose and lactose (5).

A national survey of the provision of ultrasound surveillance for the detection of hepatocellular carcinoma

OBJECTIVE

Hepatocellular carcinoma (HCC), the sixth most common cancer worldwide and third most common cause of cancer related death, is closely associated with the presence of cirrhosis. Survival is determined by the stage of the cancer, with asymptomatic small tumours being more amenable to treatment. Early diagnosis is dependent on regular surveillance and the primary objective of this survey was to gain a better understanding of the baseline attitudes towards and provision of ultrasound surveillance (USS) HCC surveillance in the UK. In addition, information was obtained on the stages of cancer of the patients being referred to and discussed at regional multidisciplinary team meetings.

DESIGN

UK hepatologists, gastroenterologists and nurse specialists were sent a questionnaire survey regarding the provision of USS for detection of HCC in their respective hospitals.

RESULTS

Provision of surveillance was poor overall, with many hospitals lacking the necessary mechanisms to make abnormal results, if detected, known to referring clinicians. There was also a lack of standard data collection and in many hospitals basic information on the number of patients with cirrhosis and how many were developing HCC was not known. For the majority of new HCC cases was currently being made only at an incurable late stage (60%).

CONCLUSIONS

In the UK, the current provision of USS based HCC surveillance is poor and needs to be upgraded urgently.

Abstract P3-06-02: Characterization of resistance to the selective CDK4/6 inhibitor palbociclib in ER positive breast cancer

Background: Dysregulation of the cyclin D-CDK4/6-Rb axis occurs in a substantial proportion of ER-positive (ER+) breast cancers and has been linked with endocrine resistance. Adding the CDK4/6 inhibitor palbociclib to endocrine treatment has led to a substantial improvement of the outcome of patients with ER+ metastatic breast cancer. However, with the increasing clinical use, acquired resistance to palbociclib is merging as a new major clinical challenge.

Methods: The ER+ cell lines T47D and MCF7 have been shown to be highly sensitive to treatment with palbociclib. Using long-term co-culture with increasing doses of Palbociclib, we generated MCF7 and T47D cell line clones with acquired resistance to Palbociclib. Three distinct resistant clones were selected for each cell line showing an IC50 shift from sensitive to resistant of approximately 300nM to 3uM for MCF7 and 400nM to 3.5uM for T47D, respectively. Resistant cell lines were characterized using RNA sequencing and mass spectrometry-based phosphoproteomics. Effects on selected target proteins (eg pAKT, pS6, pRB, RB or Cyclin D1) were confirmed using Western Blots. To modify resistance to palbociclib, a targeted in vitro drug-screen was performed using a range of inhibitors of the PI3K/AKT/mTOR and MEK pathways.

Results: Western blot analysis of resistant cell lines demonstrated sustained down-regulation of Rb and phospho-Rb in response to palbociclib, which was reversible after discontinuation of palbociclib. Mass spectrometry identified >6,000 peptides across parental and resistant cells corresponding to 4,757 phospho-peptides and 5,337 phosphorylation sites. Pathway analysis suggested increased activity in the P3IK/AKT/mTOR pathway in resistant clones (including Akt1, p90S6K and mTOR), as well as changes in p53 and apoptotic regulation (e.g. phosphorylation of BAD). In addition, resistant clones showed multiple phosphorylation changes in the Rho/Rac pathway, suggesting changes in cytoskeletal organisation and a more invasive phenotype. Targeted drug screening showed a variable pattern across resistant clones with increased sensitivity to co-treatment of palbociclib with AKT inhibitors, PI3K alpha/delta inhibitors and/or MEK inhibitors in selected resistant clones, whereas pan-PI3K or PI3K beta/delta inhibitors showed limited efficacy in the selected clones.

Conclusions: Phosphoproteomic analysis of palbociclib-resistant ER+ breast cancer cell lines demonstrated up-regulation of PI3K/AKT/mTOR and anti-apoptotic pathways. Resistant cell lines were sensitive to inhibition of PI3K/AKT/mTOR and/or MEK pathways with distinct patterns of activity across resistant clones suggesting that co-treatment of CDK4/6 inhibitors and PI3K/AKT and/or MEK inhibitors warrants further investigation as potential new therapeutic strategies in palbociclib resistance.

Citation Format: Lenihan C, Bouchekioua-Bouzaghou K, Shia A, Wilkes E, Casado-Izquierdo1 P, Cutillas P, Schmid P. Characterization of resistance to the selective CDK4/6 inhibitor palbociclib in ER positive breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-06-02.

Restaurant wheelchair accessibility

This study was designed to determine the compliance of restaurants to the wheelchair accessibility standards set forth in the Uniform Federal Accessibility Standards. The standards that were operationalized in this study are also found in Title III of the Americans With Disabilities Act of 1990. The data were collected at 120 sites in three midwestern states. For one who uses a wheelchair, parking the car is often an obstacle to eating out. Only 53% of the restaurants surveyed provide handicapped parking. Entering the building may also be a problem. Of the restaurants that required a ramp, only 66% provided them. Inside the restaurant, the key problems were accessible rest-rooms and the height of tables. The study provided comparisons between restaurants in rural and urban settings, as well as comparisons between conventional restaurants and fast food restaurants. No notable differences emerged for these comparisons.

Blue field entoptoscopy in diabetic retinopathy

Blue field entoptoscopy was performed in 50 consecutive patients with diabetic retinopathy. Several statistically significant correlations were obtained. The number of "flying corpuscles" was reduced in eyes harboring a vitreous hemorrhage, and in severe and proliferative diabetic retinopathy. On the other hand, patients with a history of focal or panretinal photocoagulation had better corpuscle counts than patients who had never received any treatment. It appears therefore, that argon laser photocoagulation is beneficial in preserving the blue field entoptic phenomenon.

Rethinking established dogma. Is good general practice possible?

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Dying now

In a random sample of 262 deaths, 21% of the patients lived alone and a quarter of the caring relatives were over 70 years old. The difficulties of the relatives were more often a cause for hospital admission than those of the patients. Health professionals and relatives differed considerably in their assessment of the same case. 24% of relatives were especially grateful to their general practitioners but 37% were critical. The uncaring attitude of the hospitals was criticised by 27% of the relatives, although hospital nurses were the most praised of all professionals. Symptom control was of variable quality. The community nurse categorised the quality of life in the final illness as poor or very poor in 44% of cases.

General practitioner in a hospice

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The diabetic, the hospital and primary care

In a survey of mainly elderly patients discharged from a hospital diabetic clinic, it was found that 41 per cent were being seen by the general practitioner only when required or not at all, 36 per cent were being seen fairly regularly, and 23 per cent at routine appointments.The transfer from hospital to primary care was popular with two thirds of these patients, mainly because of the time, trouble, and money they saved in no longer travelling to hospital.Over 20 per cent of patients thought they had been discharged from the diabetic clinic because they were cured, a further 37 per cent thought they could be cured, about a third did not test their urine, and a similar proportion admitted that they did not keep to their diet.Of 204 known diabetics examined in general practice, about half had high blood sugars, a third of lower limbs had undoubted signs of peripheral vascular disease, and one fifth of the sample had both.

Rheumatoid arthritis: review of searches for an infectious cause. Part I

No distinctive pattern has yet emerged from the accumulated mass of results that would provide a generally acceptable hypothesis of the etiology of rheumatoid arthritis. A number of immunologic aberrations have been described, but there has been no identification of a key immunologic defect that might link together the various components of the immune response into an agreed pattern. The possibility of a persistent antigenic stimulus arising from an infection cannot be confirmed or refuted. If a virus is involved, it would seem more likely to be a "slow" virus rather than a commonly recognized form, but there is no strong candidate of this type in view. Despite the fact that mycoplasmas are undoubtedly arthritogenic in other species, their role as an etiologic agent in rheumatoid arthritis has not been proven. The idea that bacterial cell wall peptidoglycan may provide a persistent stimulus has much to offer, but it is not possible at this stage to accept peptidoglycan as a recognized etiologic factor. This suggestion will, however, indoubtedly stimulate much further investigation.

A different kind of day hospital--for patients with preterminal cancer and chronic disease

A new day hospital has been set up in Sheffield for patients with preterminal cancer and chronic disease. During the first 26 months 197 patients with cancer and 66 chronically sick patients attended. Of the 2701 attendances by patients with cancer, breast cancer accounted for 38%. One hundred and forty of the patients with cancer died, 83% in the terminal-care unit and 12% at home. Ninety per cent of respondents to a questionnaire thought that the support provided was of great importance to both patient and family; and over two-thirds of the patients were said to have benefited from improved control of symptoms. A similar facility could be developed within existing day hospitals without major revenue consequences, and should produce a genuine improvement in care. This study suggests, however, that it would not shorten the terminal stay in hospital.

Mild hypertension: a clinical trial conducted in hospital general practice

To compare findings in a hospital trial of hypotensive drugs with those in a general practice trial several patients with mild hypertension were studied at the same time in hospital and in general practice. They received bendrofluazide and potassium chloride or bendrofluazide, potassium chloride, and reserpine according to a double-blind crossover protocol, and blood biochemical values were studied over eight weeks and six months. When reserpine was withdrawn from nine women they followed a modified protocol comparing bendrofluazide and potassium chloride with potassium chloride alone. The blood pressure values measured by the general practitioners were similar to those measured in hospital. Both the diuretic alone and the diuretic with reserpine produced significant falls in blood pressures. Although plasma renin activity increased on diuretic treatment, continued treatment did not produce a further increase, and levels gradually declined towards normal.

Lessons from bad general practice

The paucity of resources for general practice correlates well with high losses through emigration and questions the expensive over-production of doctors now being undertaken.The variable quality of community care and the absence of a structure yet providing real planning or capital, leads to the uneconomic abuse of hospital facilities and to an excessive emphasis on institutionalisation.Medicine is becoming depersonalised because unrealistic expectations lead to an overloading of the service. Simultaneously we allocate a low priority to education in the use of the service, have little training in the sociological aspects of medical care, and even less in how best to use the skills of our non-medical professional colleagues.

The time of synthesis and the conservation of mitosis-related proteins in cultured human amnion cells

p-Fluorophenylalanine (PFPA), an analogue of phenylalanine which may be incorporated into proteins, increases the duration of mitosis. In the present experiments, based upon quantitative analyses of time-lapse cinemicrographic films, brief treatments of cells with PFPA are shown to affect the duration of metaphase in only those cells which enter division during or shortly after treatment. The offspring of cells with prolonged metaphases also tend to have prolonged metaphases. Analyses of the kinetics of the appearance of prolonged metaphases indicate that some protein specifically associated with mitosis is synthesized primarily during a period which corresponds closely to G(2). The manner in which the defect is passed on to daughter cells indicates that the protein involved is conserved and reutilized by daughter cells for their subsequent divisions. Comparable experiments performed with low concentrations of puromycin indicate that the major effect of PFPA is due to its incorporation into protein rather than its ability to inhibit protein synthesis. The fact that puromycin-induced effects can also be passed on to daughter cells is interpreted to mean that cells make only specific amounts of some mitosis-associated proteins and that if a cell "inherits" a deficiency in such protein it is not able to compensate for the deficiency.